Leukemia (Blood Cancer)

 Sleep Apnea

            Sleep apnea is a sleep disorder that causes irregular breathing and snoring patterns that can ultimately cause apnea, which is where a person momentarily stops breathing altogether. The inability to get restful sleep can also lead to severe exhaustion. Individuals can have obstructive sleep apnea, central sleep apnea, or features of both.

Obstructive sleep apnea is the most common form, and it develops when there’s a blockage of the airways. Air has to go from the nose through the nasopharynx into the laryngopharynx, through the larynx, and then into the trachea. Somewhere along that path, there might be a blockage in the flow of air. Allergies might cause swelling of the tissue in the nasopharynx, or there might be swollen adenoid glands or tonsils because of an infection. There might be a severe overbite which pulls the jaw back and blocks the airway. In individuals that are overweight, there could be too much weight in the soft tissues of the neck, which can weigh down the airway especially when a person is lying down. These problems are most obvious at night because hormonal changes at night cause the muscles around the airway to become slightly less stiff while sleeping. This means that they are less able to keep the airway open, making it more likely to get a bit squashed or obstructed.

Central sleep apnea refers to the fact that the problem is “central” or related to the central nervous system. This is where the brain intermittently stops making an effort to breathe for 10 to 30 seconds. The apnea can persist for several seconds even after waking up, triggering feelings of panic and further disrupting the sleep cycle. Central sleep apnea starts with an initial episode of hyperpnea, which is when the brain directs the lungs to start hyperventilating during sleep by increasing the respiratory rate.

                This rapid breathing causes hypocapnia, a drop in the blood’s carbon dioxide levels. When the carbon dioxide falls below a certain threshold, the body slips into a state of apnea, making no effort to breathe and taking in no oxygen. This causes the carbon dioxide levels to rise back to normal levels and then, as the apnea persists, they keep rising to which is called hypercapnia. The really high carbon dioxide levels trigger hyperpnea again, and the cycle starts all over.

Essentially, the respiratory system is going rapidly back and forth between two states, first making no effort to breathe and then hyperventilating, with no in-between. The most common symptom of sleep apnea is severe sleep deprivation. Interrupted sleep can cause nocturia, the excessive need to urinate during the night, and stress-induced insomnia. The effects are also apparent during the day because the loss of restful sleep leads to difficulty concentrating, headaches, and fatigue. Apneic episodes are usually preceded by loud snoring, which can interrupt the sleep of other people as well. Sleep apnea on its own is rarely fatal, but it can worsen other health problems. For example, drops in oxygen levels can trigger anginal chest pain and can irritate heart cells leading to an arrhythmia—and irregular heartbeat.

Broadly speaking, individuals with sleep apnea have a higher risk for heart failure, respiratory failure, diabetes, and certain types of cancer. Diagnosing sleep apnea requires a sleep study to help identify episodes of sleep apnea, the more episodes the more severe the sleep apnea. The asleep study usually involves getting monitored overnight with a Polysomnogram.

A Polysomnogram tracks things like brain movement, oxygen, and carbon dioxide blood levels, vital signs, and outward symptoms like snoring and movement. Treating sleep apnea starts with avoiding things like sleeping pills, alcohol, and other depressant medications because they can relax the throat muscles around the airway and make the airways more likely to collapse during sleep. In addition, sleeping on the side instead of on the back can also help because it creates better airflow into the lungs. For severe sleep apnea, individuals can use a continuous positive airway pressure device or CPAP device for short. This machine forces the airways open with a steady stream of pressurized air delivered through a plastic facemask or nasal prongs. Used properly, this is very effective, but it requires continuous use. Many people eventually stop using it, finding it annoying or difficult to wear, and the problem persists. Some people with obstructive sleep apnea benefit from custom-made oral mouthpieces that help improve airflow during sleep. Sometimes, obstructive sleep apnea can be managed surgically, for example removing large adenoid tissue or realigning the jawbone; however, procedures can be complicated because the anesthesia and surgical swelling can both worsen sleep apnea in the short term.

All right, as a quick recap - sleep apnea can be due to physical obstruction of the airway or from a neurological malfunction initiated by imbalances in the blood’s oxygen and carbon dioxide levels, which regulate breathing cycles. Left untreated, the condition can interact negatively with other underlying health conditions, leading to serious complications.